Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty

A total of 45 patients with cleft lip nasal deformities were operated on be tween September 1997 and December 1999. We reviewed 35 of them. Out of thes e, 31 patients had unilateral cleft lip nasal deformities and four patients had bilateral cleft lip nasal deformities. The age range of the patients w as from 3 years to 56 years. A reverse-U incision with V-Y plasty was used in 20 patients with mild to moderate unilateral cleft lip nasal deformities . An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal defo rmities. A bilateral reverse-U incision and a trans-columellar incision wer e used in the four patients with bilateral cleft lip nasal deformities. Aft er advancement of the mucochondrial flap, alar transfixion sutures were use d to ensure firm contact between the nasal skin and the redraped reverse-U flap. A composite graft for columellar lengthening was used in six cases of severe unilateral cleft lip nasal deformity and the four cases of bilatera l cleft lip nasal deformity. Ancillary procedures included correction of a lateral displacement of the alar base, lip scar revision, a cartilage graft for tip augmentation, iliac bone grafting for correction of hypoplasia of the maxilla or for an alveolar cleft and corrective rhinoplasty. A self-mad e nasal retainer was applied for 6 months in all patients to maintain the c orrected contour of the nostril. The follow-up period ranged from 11 months to 26 months, with an average of 18 months. The final results were evaluat ed based on the degree of symmetry of the nostrils, the redraping of the al ar-columellar web and the exposure of the nostrils. Good results were obtai ned in 29 patients where alar-columellar web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was achieved. Four patients had fair results and two patients had poor results. In conclusion, we suggest that the reverse-U incision with V-Y plasty is a useful method for achieving symmetry of the nostrils in cleft lip nasal deformities in Or ientals. In addition, this technique provides ample advancement and reposit ioning of the mucochondrial flap and simultaneous correction of the nasal v estibular web. (C) 2001 The British Association of Plastic Surgeons.